Provider Demographics
NPI:1477753572
Name:BASTIAN, JALINDA ANN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:JALINDA
Middle Name:ANN
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SAXONY RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2791
Mailing Address - Country:US
Mailing Address - Phone:760-632-0081
Mailing Address - Fax:760-753-7594
Practice Address - Street 1:211 SAXONY RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2791
Practice Address - Country:US
Practice Address - Phone:760-632-0081
Practice Address - Fax:760-753-7594
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist